restorations and perio health

Question 1

what is the definitions of biological width

Answer 1

the combined width of connective tissue and junctional epithelial attachment formed adjacent to a tooth and superior to the crestal bone.”

Question 2

what is the equation for biological width

Answer 2

connective tissue attachment + junctional epithelium

Question 3

what is the approx measurement of the junctional epithelium

Answer 3

0.57-1.14mm

Question 4

what is the approx measurement of the connective tissue attachment

Answer 4

0.7-1.84mm

Question 5

what is the importance of biological width

Answer 5

Any violations to it, while providing treatment, will hinder the healthy state of the periodontium resulting in periodontal problems such as gingivitis or periodontitis. Therefore it is important to try and preserve it while providing treatment.

Question 6

what are the mean dimensions of biological width

Answer 6

2.15mm to 2.30mm

Question 7

what does biological width do

Answer 7

establishes a healthy state of the periodontium

Question 8

what issues can occur if the biological width is not maintained

Answer 8

resulting in periodontal problems such as gingivitis or periodontitis.

Question 9

what are the two main reasons we get perio problems in dentistry

Answer 9

1. plaque retentive features

2. food impaction

Question 10

what sub headings occur under plaque retentive features

Answer 10

created by the shape (3D contour) of the restoration with overhangs or ledges
deficiencies or voids at the margins or in the restoration surface
roughness of the restorative surface causing PRF

Question 11

WHAT Sub headings occur under food impaction

Answer 11

poor or no contact point
incorrect 3D contour of the supraginigval bulge in the restoration
overbuilt or under built embrasures (spillaways)

Question 12

what do we clinically need to reproduce in the tooth

Answer 12

the supraginigval bulges which help deflect food deflection

Question 13

does the incisor canine contact point have a small or large sa

Answer 13

small SA

Question 14

which contact point has a broad SA

Answer 14

canine- premolar and premolar-molar contact points

Question 15

what do we need to carry out first

Answer 15

Dietary analysis/ advice & don’t forget smoking cessation
• Oral hygiene procedures (Indices: BOP, PFS, TBI***Tooth brushing and interdental cleaning aids)
• Exposure to and the use of fluoride toothpastes (minimum 1,350 ppm Fluoride twice daily), Fluoride supplements, mouthwashes (essential oils e.g. Listerine) etc.
• Advise on oral hygiene

Question 16

if food packing inter proximally is an issue what do we need to do

Answer 16

examine the occlusion for
“Plunger cusps” abnormal cusp contact between marginal ridges, not into the normal cusp & fossae arrangement
Open or poor contact points between tooth & restoration(s) or poor embrasure design, leading to the trapping of food
Under built restorations & over erupted antagonist teeth

Question 17

what do we need to remember before carrying out a restoration

Answer 17

1. Teeth are hard tissues held in a vital and dynamic tissue matrix
2. Lost hard tissue can be “replaced” with other materials but seldom with results as acceptable as the natural tooth tissues (in terms of contour, surface smoothness, strength, aesthetics, biocompatibility, or longevity)
3. Tooth tissue loss may affect the vital supporting hard and soft tissues, in both the shorter and longer terms

Question 18

what objects can cause iatrogenic damage

Answer 18

incorrect placement of wedges and matrix bands

Question 19

what can incorrect placement of wedges and matrix bands cause

Answer 19

Gross overhangs (material extrusion)  and ledges
• Plaque retention, & caries or gingival/periodontal disease

Question 20

how dow maintain period health and gingival health

Answer 20

correct placement of wedges and matrix band

Question 21

what can correct placement of wedges and matrix bands allow for

Answer 21

• Tight contact points ; correct vertical positioning of contact points minimise plaque/food trapping ; correct 3D contour of the restoration
• Minimises voids or deficiencies in the restoration resulting in less plaque retention, caries and gingival inflammation
• No overhangs or ledges, or gross material displacement

Question 22

how can we tell that gingivitis is present when placing the matrix band

Answer 22

Spontaneous haemorrhage on preparation/ when a matrix band or strip is placed
• bleeding prevent adequate moisture control

Question 23

how can we tell that periodontitis is present when placing the matrix band

Answer 23

Will pocketing and bone loss mean poor restoration contours and aesthetics (“black triangle” disease)
• Deep subgingival floor of the restoration because of root caries
• If so, how deep before sound tissue is found, or the pulp exposed?

Question 24

what is the long term consequence of gingival and periodontal inflammation 8 things

Answer 24

1. Plaque-retaining factor/ plaque with increase in pocket formation, pocket depth with further loss of clinical attachment
2. localised alveolar bone loss
3. gingival recession
4. root caries
5. secondary caries at the restoration margin
6. associated with poor plaque control/ high consumption of fermentable carbs
7. tooth loss and significant alveolar bone remodelling
8. aesthetic issues as a result of the restoration margins becoming exposed

Question 25

what is the clinical relevance

Answer 25

PREVENTION comes FIRST!!
• Check & review baseline gingival/periodontal disease status before starting
• Correctly address any gingival/periodontal disease
• Correct any faulty restorations: refurbish/repair, modify or replace
• Always plan, design, and carry out any restorative treatment by respecting the biological width, natural tooth morphology and anatomical contact relationships

Question 26

how do we deal with faulty restorations 6 things

Answer 26

Refurbish 
modify 
repair 
refer to specialists 
leave it?
extraction

Question 27

what do we need to consider if we leave the restoration

Answer 27

if the patient does not want treatment

Question 28

what features are built into teeth to maintain healthy gums

Answer 28

the supragingival bulge which deflects food buildup

Question 29

what do we have around the supraginigval bulges

Answer 29

clean stagnation areas